UW-CTRI staff and partners presented their findings from tobacco research and outreach projects a total of nine times at the 2019 National Conference on Tobacco or Health in Minneapolis August 27-29. The following is a summary of the four presentations and five posters.
1. UW-CTRI Outreach Director Rob Adsit discussed quality measures in healthcare, which can be defined as providing patients with the right care, at the right time, in the right place. These measures are tied to ratings for healthcare systems and to federal funding. For example, Centers for Medicare and Medicaid Services (CMS) has paid approximately $16 billion to healthcare professionals and $22 billion to hospitals. “What gets measured gets done,” Adsit said. “I know it’s more cynical, but you could also say ‘What gets paid for gets done.’ We’re lucky that tobacco cessation has been one of the the core quality measures.” Adsit reported that, while 99 percent of patients have their smoking status recorded at healthcare visits, only about 70 to 85 percent are advised to quit, and about a third have a healthcare provider discuss strategies to quit tobacco use. There is room to improve. While CMS adopted compliance with all three Joint Commission tobacco performance measures as part of Inpatient Prospective Payment System for inpatient psychiatric facilities, it has not yet added compliance for general hospitals. CMS is still considering doing so for two tobacco measures.
Rob Adsit, Anne DiGuilio (American Lung Association). Application of Quality Measures to Improve Access to Cessation: A Population to Point-of-Care Perspective.
2. UW-CTRI Director Dr. Michael Fiore (left) presented on how oncology healthcare teams can use electronic health records to support the delivery of tobacco dependence treatment. Fiore said that, in the United States each year, 1.7 million people in the U.S. are diagnosed with cancer. Approximately 250,000 patients receive their cancer diagnosis at a National Cancer Institute (NCI)-designated Cancer Center. Many of these cancer patients are current smokers at the time of their oncology diagnosis. Yet only 38 percent of centers record smoking as a vital sign, and less than half have dedicated personnel to provide tobacco cessation clinical services. At baseline, the majority of Comprehensive Cancer Centers didn’t perceive treating tobacco use as one of their core services. Fiore discussed how the Cancer Center Cessation Initiative (C3I), funded by NCI, has helped 42 cancer centers integrate tobacco dependence treatment into their electronic health records and the workflow of their standard care.
3. In another presentation, federal officials unveiled the Million Hearts Tobacco Cessation Change Package (right), a manual for healthcare systems looking to improve delivery of treatment to quit tobacco dependence. UW-CTRI Outreach Director Rob Adsit and UW-CTRI Associate Director of Research Dr. Danielle McCarthy were instrumental in creating the guide, distributed at the conference and now available online. Adsit combed through about 300 resources to give clinical teams a practical resource to increase the reach and effectiveness of tobacco cessation interventions and to incorporate these interventions into the clinical workflow. There are approximately 30 resources from UW-CTRI in the guide.
Brenna VanFrank (Office on Smoking and Health), Kaitlin Graff (CDC), Rob Adsit, Gillian Schauer (University of Washington-Seattle), Danielle McCarthy, Stephen Babb (Office on Smoking and Health) Lauren Owens (CDC), Anna Schecter (Office on Smoking and Health), Hilary Wall (CDC). Building Capacity & Increasing Access to Tobacco Cessation Services for Patients with Co-Morbidities.
4. UW-CTRI Researcher Dr. Bruce Christiansen was also instrumental (behind the scenes) for a presentation on addressing tobacco cessation for pregnant women and their children.
Krissy Alaniz, Carolyn Runge, Katelyn Rupp, Bruce Christiansen. Addressing Cessation in Maternal/Child Health.
1. UW-CTRI Researcher Dr. Bruce Christiansen (left) presented his poster on the Bucket Approach to help people with serious mental illness to quit smoking. The Bucket Approach delineates specific, brief interventions tailored to the behavioral and motivational state of the smoker. Christiansen promoted two online trainings—one current training to help behavioral health providers integrate tobacco policy and treatment into their standard care that comes with six free continuing education credits, and another new training coming this fall based on the Bucket Approach.
Bruce Christiansen, Donna Riemer (Department of Health Services), Karen Doster (DHS). “Bucket Approach”: Tobacco Dependence Interventions Based on Evidence-Based Practice and Tailored to Those with Significant Mental Illness.
2. ClearWay Minnesota Vice President Paula Keller, a former UW-CTRI researcher, presented her poster, “Engaging Tobacco Users In Population-Based Cessation Services: Findings From an Observational Study.” Her co-authors included UW-CTRI colleagues Kate Kobinsky and Dr. Bruce Christiansen. They found that providing tobacco users with both service options and registration options increased both the number and proportion of smokeless tobacco users who enrolled in quitline services in Minnesota.
Paula Keller (ClearWay Minnesota), Raymond Boyle (University of California), Becky Lien (Professional Data Analysts), Bruce Christiansen, Kate Kobinsky. Engaging Tobacco Users In Population-Based Cessation Services: Findings From an Observational Study.
3. TingTing (Emily) Sullivan of the Wisconsin Womens’ Health Foundation and UW-CTRI Researcher Dr. Bruce Christiansen presented their poster on how to help low-income pregnant women quit smoking. They found that, while highly successful for 18 years, the First Breath program had to evolve to address: 1. Changes in funding in the broader context of providing prenatal services to low-income women. 2. High postpartum relapse. 3. Expansion of services to family members. 4. A desire to increase its reach.
Kristine Alaniz (WWHF), Bruce Christiansen, Emily Sullivan (Wisconsin Women’s Health Foundation), Lisette Khalil (WWHF), Michael Fiore.
4. UW-CTRI Outreach Director Rob Adsit (above left) and UW-CTRI Outreach Specialists Allison Gorrilla and Amy Skora (far right) presented their poster to a steady stream of viewers interested in learning about how health systems can use their electronic health records (EHR) to refer patients to tobacco quitlines (eReferral). They found that emphasizing eReferral’s concordance with health system goals can spur buy-in and support. They shared that serving as a hub for building and testing EHR can aide in helping systems adopt tobacco treatment into their unique EHR systems. Training and evaluation can help systems integrate tobacco treatment into their clinical workflow. Ongoing feedback and support can keep tobacco treatment at the forefront for busy systems with competing priorities.
5. David “Mac” MacMaster presented a poster promoting A Time to Lead, a call to action for behavioral healthcare providers to incorporate tobacco dependence treatment into their standard care, as well as a document on how to do so. MacMaster discussed how LE Phillips Libertas in northern Wisconsin has successfully accomplished just that, with training and technical assistance from the Wisconsin Nicotine Treatment Integration Project (WiNTiP).
David Macmaster (WiNTiP), Jim Wrich (advocate). The Case for Integrating Tobacco Use Disorder Treatment in Substance Use and Mental Health Disorders.
1. Heather D’Angelo (right), a collaborator with UW-CTRI from the UW Carbone Comprehensive Cancer Center, also presented on the Cancer Center Cessation Initiative (C3I), reporting that the project helped bolster the use of treatments—including medications, quitline referrals, and in-person counseling—to quit smoking among participating cancer centers from 2017 to 2018. This is due, in part, to the cancer centers incorporating tobacco treatment into their electronic health records and referring patients to cessation services electronically. D’Angelo said reach varied by setting, program type, patient age and other demographics. One challenge is how to balance the need for care with treatment intensity.
2. Kate Kobinsky (left) presented at the 2019 North American Quitline Consortium 2019 Meeting, a pre-conference to the National Conference on Tobacco or Health in Minneapolis.
Kobinsky presented as part of the workshop called “Evolving Approaches to the Management of Quit Lines.” The panel pertained to using new and emerging technologies within quitlines. Kobinsky presented how healthcare providers have evolved from referring patients who use tobacco to quitlines via fax to referring them via electronic health records (eReferral), and the pros and cons of each. She highlighted Wisconsin’s experience implementing eReferral.